Alopecia

Some shedding of hair is part of the natural cycle of hair growth, rest, shedding and replacement.We shed about 50 – 100 hairs a day, but new ones normally grow back to replace them. When you lose more hair than you replace this results in bald patches or thinning of hair.

While hair loss may seem like a cosmetic issue it can have negative psychological effects. Both male and female pattern baldness, for example, is associated with low self-esteem, depression and social isolation. Women tend to express being more emotionally impacted by hair loss than men.

Hair loss typically occurs with aging, and is slightly more common in men than in women. But it can also happen for other reasons, such as after major surgery, after childbirth or due to another physical or psychological form of stress. It can also be attributed to underlying diseases such as lupus and iron deficiency, because of a hormonal imbalance or with the use of certain medications.

Male pattern baldness — Known as androgenetic alopecia, this condition is marked by a receding front hairline and hair loss at the top of the head. It is believed to be related to genetic makeup and hormone levels. Male pattern baldness affects about 50 per cent of men. It can start as early as in one’s teen years. Four out of five men will have some degree of baldness by age 70.

Female pattern baldness (also known as androgenetic alopecia) usually involves thinning of hair on the top, or the “crown” of the scalp. About 40 per cent of women experience some signs of thinning hair by age 50. Genetics is believed to be involved, as well as some hormonal effect.

Alopecia areata typically results in round bald patches that occur randomly on the scalp, face or body. This is an autoimmune disease where your immune system attacks your body’s hair follicles, often causing hair to come out in clumps. It occurs in 2% of the population in some form over their lifetime.

Alopecia totalis is a more severe form of alopecia areata marked by total hair loss on the scalp. It results in complete scalp baldness.

Alopecia universalis is the most severe form of alopecia areata, and is defined by loss of all scalp and body hair. It is rare, affecting just 1 per cent of those with this condition.

Trichotillomania is a self-induced form of hair breakage and alopecia caused by the compulsive twisting and twirling of hair. It can result in broken hairs and a patchy distribution of hair loss. This form of hair loss is primarily treated by changing one’s behaviour or modifying one’s habits.

Scarring alopecias are categorized as a large group of disorders that can lead to permanent hair loss, usually on the scalp. They occur in about 3 per cent of people with hair loss and result in permanent loss of the hair follicles, which are replaced with scar tissue. These alopecias are generally diagnosed by taking a skin sample (biopsy), and require expert management by a dermatologist. In most cases of scarring alopecia, hair regrowth is not possible. Instead, the goal of treatment is to prevent further progression.

Permanent hair replacement through an in-office surgical procedure called hair transplantation may be an option for some cases of pattern baldness or “androgenetic alopecia”. Hair transplantation involves removing bits of scalp that have intact hair follicles from where there is still healthy hair growth (usually back or sides of head). These follicles are then grafted onto bald areas, and hair growth usually appears after several months. The procedure is done while one is awake using just local anesthetic, but it can still involve some pain or discomfort. Bleeding, infection, scarring and unnatural-looking growth are possible adverse effects. Computer-guided robotic systems are now being used to remove and implant hair follicles in addition to trained physicians.

In most cases, due to the pattern of hair loss, men are better candidates for hair transplantation than women. Although hair transplant effects are not permanent, hair can be preserved for decades.

Hair loss may be temporary or permanent, depending on the cause. With male and female pattern baldness, the most common type of hair loss, hair usually does not grow back to its pre-hair loss state.

While many remedies are advertised to slow thinning hair, or promote new hair growth, only a few drugs* have been proven effective. Minoxidil (Rogaine) is a foam or solution applied directly to the scalp (topically) that can be used by both men and women. It is effective in treating many types of alopecia. Finasteride and dutasteride are oral medications that can stabilize male pattern baldness. For female pattern baldness, finasteride and dutasteride are options for treatment, in addition to the medication spironolactone (Aldactone). Finasteride and dutasteride are dosed differently in men than in women. Patients with alopecia areata and its variants can be treated with topical corticosteroid preparations or doctor-performed injections of the steroid triamcinolone acetonide directly at the hair loss site. For alopecia totalis, topical applications of DPCP are available at specialized centres. Another medication that can be used to grow hair in severe alopecia areata or alopecia totalis is anthralin lotion. In cases that are progressing rapidly, some success has been achieved with the steroid prednisone. Some patients have achieved significant hair regrowth by taking other medications, such as cyclosporine, methotrexate, or sulfasalazine. In all cases, these prescription drugs require close monitoring by one’s physician to help identify and manage potential side-effects.

*Please note that mention of a medication or brand name does not constitute a recommendation for the product by the Canadian Dermatology Association.